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USMLE World Q Bank > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

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USMLE® Step 1 flashcards
1
Q

What is the most common injury in children when their arm is pulled?

A

Nursemaid’s Elbow is a radial head subluxation caused by a tear of the annular ligament. Children present with the arm close to the body, elbow extended and forearm pronated.

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2
Q

What is the most commonly injured elbow ligament in throwers?

A

Ulnar Collateral Ligament due to the high valgus stress.

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3
Q

What is the most commonly injured nerve of the leg? Why? What does it innervate?

A

Common Peroneal Nerve. It wraps around the fibula at a very superficial level. It innervates muscles of dorsiflexion and eversion.

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4
Q

Achondroplasia, early closure of the growth place, is most often due to a mutation of what gene in which cells?

A

Fibroblast Growth Factor Receptor 3 in Chondrocytes

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5
Q

Which drugs are known to cause drug-induced SLE?

A

Hydralazine
Procainamide
Isoniazid
(All of which are metabolized via acetylation in the liver. Slow acetylators are more likely to develop SLE)

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6
Q

What is a marker of osteoblast activity?

A

Serum Bone Specific Alkaline Phosphatase

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7
Q

What is a marker of osteoclast activity?

A

Urinary deoxypyridinoline

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8
Q

What is the triad of reactive arthritis?

A

non-gonococcal urethritis, conjunctivitis, and arthritis (may also present with sacroiliitis)

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9
Q

What is most likely to be injured on a sudden upward jerk of the arm (ie. swing)?

A

Lower Trunk of the Brachial Plexus and it should present with HAND weakness.

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10
Q

What are the differences between Mysthenia Gravis and Lambert-Eaton Syndrome?

A

LE is a paraneoplastic disease caused by Anti-Ca-channel Ab in the presynapse. Repetition of movement improves strength and in MG it does the opposite. The Edrophonium test is negative in LE but positive in MG.

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11
Q

What is the first line treatment for acute gouty arthritis? Second? Third?

A

1 - NSAIDs, 2 - Glucocorticoids, 3 - Colchicine

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12
Q

What is alendronate used for? What is the mechanism of action?

A

It is a pyrophosphate analog used to treat osteoporosis.

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13
Q

What is the most common shoulder joint injury and what nerve is usually damaged?

A

Dislocation (anterior, inferior or posterior) and the Axillary nerve (innervation to the skin on the outside of the upper arm) is damaged.

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14
Q

What is polymyalgia rheumatica? What other disease is it associated with?

A

Hip, shoulder and joint pain with fever, weight loss and malaise. Assc. w/ Temporal (Giant cell) Arteritis. Elderly females.

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15
Q

Which drugs inhibit COX? (Four groups)

A

Aspirin, NSAIDs, Celecoxib (COX2 only), & Acetaminophen,

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16
Q

Name the five most commonly used NSAIDs?

A

Ibuprogen, Naproxen, Indomethacin, Ketorolac, Diclofenac

17
Q

What is the mechanism of action of Celecoxib?

A

Unlike the other COX inhibitors, it only inhibits the COX2 isoform so it has no effect on the GI mucosa or platelet aggregation. GIVE IT TO AVOID THE SIDE EFFECTS.

18
Q

What is the common presentation of a scaphoid fracture? What is the most likely consequence?

A

Fall on outstretched hands with mild swelling and point tenderness on the anatomical snuff box. It can lead to avascular necrosis of the medial part of the bone as scaphoid artery coming from the radial artery is injured.

19
Q

Injury to what nerve (and which muscle) causes winging of the scapula?

A

The long thoracic nerve which innervates the Serratus Anterior. Can happen in radical mastectomies.

20
Q

What is etanercept?

A

A TNF-alpha inhibitor that is used for RA, Psoriasis and Ankylosing Spondylitis.

21
Q

What is the first line treatment of psoriasis?

A

Calcipotriene (a topical Vitamin D analog) inhibits keratinocyte proliferation and stimulates keratinocyte differentiation.

22
Q

What signaling pathway induces glycogen breakdown in myocytes?

A

Tricky questions. During contraction the increase in Ca++ can activate Phosphorylase Kinase activity. PKA can also activate it but it does so through the Gq pathway with alpha1 and NE.

23
Q

What is the role of troponins in muscle contraction?

A

In skeletal muscle when Troponin C is bound by Ca++ the tropomyosin chain moves to uncover the binding site on actin filaments. The troponin complex (I, T & C) are bound to tropomyosin by T.

24
Q

Compare and contrast osteoarthritis versus rheumatoid arthritis.

A

OA: Morning stiffness that last LESS than 30 minutes. Use dependent pain. Weight bearing joints and DIP.
RA: Morning stiffness that last hours and gets better with use. Involves MCP and PIP joints.

25
Q

What factor is most responsible for bone mass density?

A

Genetics.

26
Q

What are the risk factors for osteoporosis? Try to remember them in order.

A
  1. Smoking
  2. Menopause
  3. Corticosteroids
  4. Physical inactivity
  5. Caucasian race
  6. Low body weight
  7. Alcohol use
27
Q

For what step in striated muscle contraction is ATP required?

A

The ATP is used in order for the Myosin chain to release the Actin chain.

28
Q

Describe the interaction between troponin and tropomyosin.

A

Tropomyosin is the long filament blocking the myosin binding sites on actin. Troponin is bound to tropomyosin and causes it to move when Ca+ ions bind troponin.

29
Q

What is the mechanism of action of Etanercept?

A

It is a decoy receptor (-cept) for TNF-alpha. Used for RA, Juvenile Arthritis, Ankylosing Spondylitis, and Psoriatic Arthritis.

30
Q

Classify the COX Inhibitors.

A

Aspirin = Irreversibly inhibit both 1 and 2.
NSAIDs (Ibufrofen, Naproxen, Indomethacin, ketorelac, & diclofenac) = Reversibly inhibit both 1 and 2.
Acetaminophen = Same as NSAIDs but CNS only.
Celecoxib = Reversible COX2 inhibitor.

31
Q

Which protein is associated with contractures?

A

Matrix Metalloproteinase (MMP) is secreted by many different cell types. Myofibroblast accumulation is seen histologically.

32
Q

What are the four most important rotator cuff muscles? Name their action.

A

Supraspinatus = Abducts
Infraspinatus = External Rotation
Teres Minor = Adducts and external roation
Subscapularis = Internal Rotation and adducts

33
Q

What is the presentation of Myotonic Dystrophy?

A

Caused by a trinucleotide repeat mutation to disease causes myotonia, frontal balding, cataracts and gonadal atrophy.

34
Q

What are the differences between gout and pseudo gout?

A

Gout: Monosodium Urate crystals that are (-) birefringent (yellow in parallel light)
Pseudogout: Calcium pyrophosphate crystals that are (+) birefringent (blue on parallel light)

35
Q

Name the bones of the hand.

A

Proximal: Scaphoid, Lunate, Triquetral, Pisiform
Distal: Trapezoid, Trapezium, Capitate, Hamate. (Organized from radial to ulnar) (Some lover try positions that they cannot handle.)

USMLE World Q Bank (14 decks)

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